Reframing Inflammaging: A Clinical Perspective on Acupuncture, Chinese Herbal Medicine, and Ageing

Rethinking Qi in Modern Clinical Terms

Inflammaging—a term now well established in the biomedical literature—describes low-grade, persistent inflammation that accumulates with age. It underpins many of the chronic, non-specific symptoms we see in older patients: fatigue, musculoskeletal pain, poor sleep, digestive slowing, and decreased resilience.

These symptoms often present before frank pathology is measurable, making early intervention both difficult and crucial. This is where Traditional Chinese Medicine (TCM)—particularly acupuncture and Chinese herbal medicine—offers a valuable, evidence-aligned framework.

🩺 Rethinking Qi in Modern Clinical Terms

Much of the scepticism surrounding TCM arises from historical mistranslations. Notably, the French diplomat Georges Soulié de Morant inaccurately translated the Chinese term qi (氣) as “energy” or “life force,” leading to an entrenched but misleading Western interpretation.

A more accurate understanding recognises qi as functional physiology—the body’s capacity to metabolise, transport, regulate, and maintain internal coherence. In clinical terms, this includes:

• Oxygen delivery and blood circulation

• Tissue repair and immune responsiveness

• Hormonal regulation and autonomic rhythm

• Mitochondrial output and metabolic resilience

Where qi is impaired, we often see fatigue, inflammatory tone, poor recovery, and impaired circulation—exactly the clinical phenotype of inflammaging.

🌿 TCM Definition of Health

In Traditional Chinese Medicine, optimal health is defined by:

• A constant supply of well-nourished, oxygen-rich blood reaching all tissues

• A system in which metabolic, immune, and circulatory functions are coordinated and regulated

• The capacity for repair, adaptation, and resilience in response to stressors

Inflammaging, through this lens, is understood as a progressive breakdown in these coordinated functions—often involving what TCM describes as “qi and blood deficiency,” “internal dampness,” or “Liver constraint.”

🔬 Acupuncture: Regulating Inflammation and Resilience

Mechanisms of Action:

• Modulates inflammatory mediators including TNF‑α, IL‑6, and CRP

• Enhances vagal tone and HPA axis regulation, improving autonomic balance and HRV

• Increases microcirculation and perfusion, supporting mitochondrial and immune function

• Activates descending pain modulation pathways, reducing nociceptor hypersensitivity

Evidence:

• A large meta-analysis (Vickers et al., 2018, JAMA Internal Medicine) showed acupuncture has statistically and clinically significant effects for chronic pain, particularly in musculoskeletal conditions.

• A randomised controlled trial by Kim et al. (2015) demonstrated that acupuncture significantly reduced fatigue severity in patients with idiopathic chronic fatigue.

Clinical Relevance:
Patients experiencing early inflammaging symptoms—particularly pain, fatigue, poor sleep, and stress sensitivity—often respond favourably to regular acupuncture. This provides a non-pharmacological, well-tolerated adjunct to conventional care.

🌿 Chinese Herbal Medicine: Internal Regulation and System Support

Mechanisms of Action:

• Many formulas exhibit anti-inflammatory, antioxidant, and immunomodulatory properties

• Targets systemic drivers of dysfunction: poor digestion, impaired detoxification, fluid stagnation, and tissue undernourishment

• Supports gut–immune integrity, endocrine balance, and constitutional recovery

Evidence:

• A 2022 meta-analysis of 84 RCTs (Zhang et al., Frontiers in Pharmacology) concluded that Chinese herbal medicine significantly reduced fatigue, improved quality of life, and lowered inflammatory markers in patients with chronic fatigue syndrome.

• Experimental pharmacology studies have shown that many Chinese herbs modulate pathways involving NF-κB, COX-2, and IL-1β.

Clinical Relevance:
For patients who present with vague, multisystem complaints but no clear pathology, Chinese herbal medicine offers whole-system regulation that is difficult to achieve with targeted drugs alone.

🔄 Integration into Conventional Practice

Acupuncture and Chinese herbal medicine do not need to replace biomedicine—they can enhance and complement it.

• Help patients tolerate physiotherapy, exercise, or dietary changes

• Improve quality of life and reduce symptom burden in chronic disease

• Provide proactive support before pharmaceutical intervention becomes necessary

• Bridge the gap between lifestyle advice and actual physiological regulation

🧠 For the Sceptical Practitioner

It’s understandable to approach TCM with caution. The language is unfamiliar, the framework is different, and mistranslations have muddied its reception in the West.

But that tide is turning.

There is a growing body of RCTs, pharmacological research, and neuroimmunological studies validating many of TCM’s foundational concepts—especially in areas where conventional medicine lacks whole-system tools.

By referring patients early—for acupuncture and/or herbal consultation—you’re not endorsing mysticism. You’re expanding care options and offering a pathway that has already helped millions worldwide.

✅ Clinical Takeaways

• Inflammaging is real, modifiable, and best addressed early.

• “Qi” reflects the body’s physiological competence—circulation, regulation, recovery.

• Acupuncture and Chinese herbal medicine improve resilience, reduce inflammation, and support function.

• RCTs increasingly support these modalities as safe and effective adjuncts.

• Early referral improves outcomes—and may prevent decline.

📍 On the Pulse Clinic, South County Dublin
🔗 onthepulse.clinic | Integrated, evidence-informed care for ageing and chronic inflammatory conditions

⚡ Pain, Fatigue & Mitochondrial Crosstalk

Pain, Fatigue & the Mitochondria

A Traditional Chinese Medicine informed clinical perspective.

A TCM-Informed Clinical Perspective

Low-grade chronic inflammation in ageing patients quietly sensitises pain receptors and disrupts mitochondrial energy production. This results in a clinical constellation often seen in older adults:

• Persistent, nonspecific muscle or joint pain

• Reduced physical resilience and easy fatigability

• Non-restorative sleep and heightened sensory sensitivity

• “Idiopathic” fatigue that doesn’t respond to conventional therapies

Emerging biomedical evidence highlights a bidirectional relationship: inflammation impairs mitochondrial function → lower ATP output → more reactive oxygen species (ROS) → further inflammation → more mitochondrial damage. This vicious cycle underpins syndromes like fibromyalgia, chronic fatigue, and frailty. 💡

🧠 TCM Interpretation

From a Traditional Chinese Medicine (TCM) standpoint, this clinical picture is interpreted as a combination of:

• Qi deficiency (particularly of Spleen and Lung), leading to poor energy production and sluggish recovery

• Damp accumulation, causing heaviness, slowed metabolism, and impaired sleep

• Yin deficiency, with internal heat and restlessness disrupting repair

• Liver constraint, contributing to tension, irritability, and disrupted sleep-wake cycles

In TCM, these patterns guide treatment toward restoring systemic balance, supporting energy metabolism, clearing internal heat, and enhancing organ-level regulation—rather than focusing solely on symptom suppression.

🧩 Clinical Utility of TCM in Mitochondrial–Inflammatory Syndromes

• Holistic root-targeting: TCM’s systemic framework addresses mitochondrial impairment not as an isolated issue, but as one aspect of a broader dysfunction in qi, fluids, and organ coordination.

• Complementing standard care: By restoring energy regulation and reducing inflammatory burden, TCM interventions support recovery, improve quality of life, and help break the inflammation–mitochondrial damage cycle.

• Personalised approach: Variations in TCM patterns (e.g., “qi deficiency” vs “yin deficiency”) allow nuanced, individualised treatment—tailored to a patient’s deeper constitutional state.

✅ Supporting Evidence

1. Chinese herbal medicine for chronic fatigue
A large meta-analysis of 84 RCTs (n = 6,944) found that Chinese herbal medicine significantly reduced fatigue scores (WMD –1.77, 95% CI –1.96 to –1.57, p < 0.001) in chronic fatigue syndrome, alongside improvements in mood and inflammatory markers.
Reference: Zhao, J., et al. (2022). Frontiers in Pharmacology, doi:10.3389/fphar.2023.1266803

2. Acupuncture ameliorates mitochondrial stress
A controlled clinical study demonstrated that acupuncture reduced ROS-induced metabolic imbalance and improved biomarkers of cellular energy metabolism in patients with fatigue—suggesting acupuncture directly supports mitochondrial function impaired by inflammation.
Reference: Lu, C., et al. (2015). Evidence-Based Complementary and Alternative Medicine, PMC4579316

💡 Clinical Takeaways

• If your patient—particularly one aged 60 and older, or even in their 40s or 50s with chronic stress, hormonal changes, or low-grade inflammation—presents with multisite pain, unrelenting fatigue, and poor sleep, especially without clear biomedical pathology, consider the role of inflammation–mitochondrial dysfunction.

• Traditional Chinese Medicine offers system-level interventions that support energy metabolism, reduce inflammatory burden, and promote tissue repair—addressing root causes rather than isolated symptoms.

• These strategies can be safely integrated with standard care, helping to enhance resilience, reduce symptom burden, and support meaningful recovery—particularly in complex, idiopathic, or treatment-resistant cases